Tag Archives: future trend articles

By Aaron Boatin

Most healthcare providers send text messages and emails throughout their day. Unfortunately many choose unsecured methods of transmission. This is bad news for protecting patient data and worse yet, a clear HIPAA violation.

Embracing technology to increase the speed of healthcare is a good thing, but only if it’s done right. This means encrypting protected health information (PHI), to ensure the privacy protection mandated by HIPAA and HITECH.

Managing Protected Health Information with Secure Text Messaging

Standard texting on cell phones and alpha/text pagers is not HIPAA compliant. However, implementing secure text messaging for providers is a painless process, and allows users to receive HIPAA-compliant, secure text messages using a smartphone.

Secure messaging apps allow medical practices to stay on top of their customer service, anywhere they may be, and remain HIPAA compliant. App capabilities vary, but look for one with powerful enterprise paging and messaging application built for Apple iOS and Android mobile phones and tablets. This can replace or supplement current paging technology and enables instant two-way communications.

It’s ideal for organizations where HIPAA compliance is a necessity or when sensitive data needs to be securely delivered to mobile devices. When the recipient receives a new message alert, the secure message can be viewed instantly using the secure messaging app. The secure messages are kept separate from email and text messages.

Socket Layer (SSL) Technology

Call centers that serve the medical community should seek solutions that offer compliance, privacy, and sender/receiver authentication, using 256-bit encryption SSL technology. This exceeds compliance standards and is the same technology that protects sensitive information on major websites that offer secure online transactions.

Other ways that most secure messaging apps are useful to medical practices complying with HIPAA and increasing efficiency include:

Reporting with an audit trail of all messages with all message events.

Management of Secure Text Messaging for Medical Practices

The management of secure text messaging users is easy. For some apps, the management of devices is done through a web portal so that staff can add, delete, or change user settings. If a device is lost or stolen, the data on the phone can be deleted using the remote wipe function.

Secure text messaging solutions work by hosting the encrypted PHI on hosted secure servers. The phones then access this secure data via the secure texting app. This is a great solution for medical practices where most providers use their own phones. It fits in perfectly with BYOD policies in place at large healthcare organizations.

The best apps mimic the ease of use of regular text messaging, making adoption easy and intuitive. They also bring several nice enhancements and integrations. For example, the ability to send and receive images (x-rays for example) and audio files saves an enormous amount of time.

Many medical practices that have implemented secure text messaging have seen boosts in productivity. Aside from HIPAA compliance, the speed of communications accelerates dramatically. This has a direct positive effect on patient care.

Encrypted Email

Standard email is not HIPAA compliant. Without email encryption, email sent from one user to another is vulnerable at any point along that transfer route. Using unencrypted email not only puts the content of the information at risk but also the identities of the sender and receiver.

To provide additional protection for email communication in transit and keep electronic communication from prying eyes, companies often apply encryption methodologies to their electronic communication. Encrypted email refers to the process of encoding email messages in such a way that eavesdroppers or hackers cannot read it, but that authorized parties can.

There are two popular options for encrypting email. They are TLS and Secure/Multipurpose Internet Mail Extensions (S/MIME) encryption methods.

TLS Encryption: Transport Layer Security transcription (TLS) protocol prevents unauthorized access of emails while they are in transit. TLS is a protocol that encrypts and delivers email securely for inbound and outbound email.

It helps prevent eavesdropping between email servers. It’s worth noting that email messages are encrypted only if the sender and receiver both use email providers that support transport layer security.

S/MIME Secure Email: S/MIME (Secure/Multipurpose Internet Mail Extensions) is a widely accepted method for sending secure email messages. It allows users to encrypt emails and digitally sign them. It gives the recipient the peace of mind that the message they receive in their in box is the exact message that started with the sender.

It also ensures the person receiving the email knows it really did come from the person listed in the “From:” field. S/MIME provides for cryptographic security services such as authentication, message integrity, and digital signatures.

Conclusion

Putting it all together is a challenging endeavor, but doing nothing is risky for your organization and the patients’ PHI that is vulnerable for interception.

Aaron Boatin is president of Ambs Call Center, a virtual receptionist and telephone answering service provider, that specializes in medical answering services. His passion is helping clients’ businesses succeed. Melding high tech with high touch to provide the best customer service experience for clients is his core focus.

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Should We Embrace Technology in Our Medical Contact Centers or Fear It?

By Peter Lyle DeHaan, PhD

Throughout the history of the call center industry we’ve looked for ways to help our agents be more effective. In the pre-computer days this often meant physical solutions and electromechanical devices that allowed staff to answer calls faster, record information easier, and organize data more effectively.

Then came rudimentary computers that provided basic call distribution and CTI (computer telephony integration). Computer databases allowed us to retrieve information and store data. Following this we experienced voicemail, IVR (interactive voice response), and automated attendant. More recently we’ve encountered speech-to-text conversion and text-to-speech applications. Then came the chatbots, computerized automatons that allow for basic text and voice communication between machine and people.

Computers are talking with us. Smart phones, too. Consider Siri, Alexa, and all their friends. Technology marches forward. What will happen next?

I just did an online search for Voice AI. Within .64 seconds I received two million results. I’m still working my way through the list (not really), but the first few matches gave me some eye-opening and thought-provoking content to read and watch.

In considering this information, it’s hard to determine what’s practical application for our near future and what’s theoretical potential that might never happen. However, my conclusion is that with advances in chatbot technology, artificial intelligence (AI), and machine learning, we aren’t far from the time when computer applications will carry on full, convincing conversations with callers, who will think they’re talking with real people.

What Does Voice AI Mean for the Medical Call Center?

Just like all technological advances since the inception of the earliest call centers, we’ll continue to free agents from basic tasks and allow them to handle more complex issues. Technology will not replace agents, but it will shift their primary responsibilities.

Or maybe not.

With the application of voice AI, might we one day have a call center staffed with computer algorithms instead of telephone agents? I don’t know. Anything I say today will likely seem laughable in the future. Either I will have overstretched technology’s potential or underestimated the speed of its advance.

I think I’m okay talking to a computer program to make an appointment with my doctor. And it wouldn’t bother me to call in the evening and converse with a computer as I leave my message for the doctor, nurse, or office staff. However, what concerns me just a tad would be calling a telephone triage number and having a computer give me medical advice.

Yet in considering the pieces of technology available to us today, this isn’t so far-fetched. Proven triage protocols are already defined and stored in a database. Giving them a computerized voice is possible now. And with AI and machine learning, the potential exists for an intelligent interface to provide the conversational bridge between me and the protocols. And this could be the solution to our growing shortage of medical practitioners.

For those of you actually doing telephone triage, you might be laughing right now. Perhaps you’re already implementing this. Or maybe you’re convinced it will never work.

Yet it’s important that we talk about technology and its application in healthcare call centers. Regardless of what happens, the future will certainly be an interesting place.

Peter Lyle DeHaan, PhD, is the publisher and editor-in-chief of AnswerStat. He’s a passionate wordsmith whose goal is to change the world one word at a time.

Patient Experience Failure: Currently healthcare has a 29 percent patient experience failure rate, according to research by Hospital Compare. Only 71 percent of inpatient patients receiving care report that they received the “Best Possible Care.”

In what universe is a 29 percent failure rate acceptable? Could we miss revenue projections by 29 percent? Be over budget by 29 percent? Would it ever be acceptable to miss quality standards by 29 percent? “We only dropped 29 percent of newborns, so we met the standard.” Seriously?

“Best Possible Care” experiences begin before a patient receives care and continues after the patient returns home. Healthcare contact centers are uniquely positioned. They serve as the virtual front door for personalized support and referrals before using a clinical service and for individualized follow-up and coaching after discharge.

With the launch of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) program by CMS in 2006, hospitals have dedicated significant time and resources to improving the results of CAHPS surveys. The shift from a transaction-focused call center to an experience-driven contact center is an investment to improve the experience of care beginning at the first touchpoint when someone new to the community calls to request a referral to a primary care physician (PCP), to after discharge when a contact center navigator calls to confirm a follow-up visit with that PCP.

That first touchpoint is critical. According to SHSMD (2012), the first three seconds of that initial interaction influences hospital selection and preference. Whether on the phone or online, healthcare contact centers can intentionally deliver a transformative first patient experience.

Patient experience contact centers respond: A large, backlit sign at the entrance to a leading healthcare contact center boldly proclaims: “We own the patient experience.” At another, team members wear purple t-shirts that announce in large white letters: “I give phone hugs!”

Yet another patient experience contact center conducts their own ongoing patient satisfaction surveys to identify opportunities for improvement before the next CAHPS survey is conducted. By the time the CAHPS results are published, they have proactively improved their scores.

Incentivized Reduction of Avoidable Readmissions: One-half of all hospitals in the United States (2,597) will be penalized by the Centers for Medicare & Medicaid Services (CMS) for unnecessary readmissions in FY 2017. In 2017, penalties will total $528 million, over $100 million more than in FY 2016. During 2016 forty-nine hospitals received the maximum penalty of 3 percent withholding from Medicare funding. A total of 1,621 hospitals have been fined over each of the five years. (Source: HealthStream SUMMIT 2016)

Preventable readmissions represent a substantial portion of unnecessary medical spending. According to data from the Center for Health Information and Analysis (CHIA), the estimated annual cost of this problem for Medicare is $26 billion annually, $17 billion of which is considered avoidable. (Source: Provider Advisor 2016 Volume 2, Issue 2 p 4.)

Patient experience contact centers respond: A leading Midwest health network was fined $2.5 million for excessive preventable readmissions. The patient experience contact center became an intentional, centralized source for reducing avoidable readmissions. Here’s what they achieved:

Readmission rate declined from 25 to 15 percent

$2.5 million fine from CMS was reduced by $1.9 million over two years

The contact center asks patients at discharge for permission to contact a family member or caregiver—and store that information in the patient record—to be accessed when it’s time to make certain they are able to get to their follow-up physician appointment. They have raised the kept appointment rate for post-discharge physician visits to 87 percent.

As many as one in three physicians is suffering from burnout, which is linked to a list of pervasively negative consequences including lower patient satisfaction and care quality, higher medical error rates, greater malpractice risk, higher physician turnover, physician alcohol and drug abuse and addiction, and physician suicide. (Source: Dike Drummond, MD “Stop Physician Burnout”)

Physicians face increasing burdens including the complexities of ICD-10 coding; new billing models; responding to new government regulations; dealing with a changing landscape of health plans; sharing information across the network; inefficiencies of credentialing, provider enrollment and onboarding; documenting quality, cyber security, loss of autonomy, threats from alternative providers; and the “retailization” of primary care.

And, here comes the value-based reimbursement plan for physicians: MACRA (Medicare Access and CHIP Reauthorization Act). Beginning in 2019, physicians will be reimbursed on various performance metrics including quality, advancing care quality, resource use, and clinical practice improvement. According to Deloitte, “Providers are in for a notable awakening when the law takes place in 2017.”

On top of this avalanche of stressors a physician must keep up to date clinically, build practice volume, and improve their patients’ experiences. Are you exhausted yet?

Patient experience contact centers respond: Patient experience contact centers are providing resources to serve as practice extenders: decreasing the burden and filling their practices. One locates a contact center ambassador in each of their emergency departments to capture patients without a PCP, and keep them in network. It has become a gift that keeps on giving with a steady stream of newly aligned patients referred to in-network primary care physicians.

Another built a network of family medicine centers and established a patient experience contact center to fill the practices. Still another focused their contact center on physician-to-physician consults for referring physicians to the health system’s specialists and sub-specialists. They received physician-to-physician referrals from dozens of states and several foreign countries. Annual multimillion-dollar results prompted the organization’s president to declare the contact center as her “secret weapon.”

Several patient experience-focused contact centers now include patient ratings and the comments in online provider directories. The scores and comments about a particular physician from previous patients give prospective patients vital information and increase the likelihood of a good match between patient and provider.

Growing focus on Revenue Cycle Management: The Affordable Care Act (ACA) and Medicaid expansion has created an influx of previously uninsured patients that has left healthcare organizations scrambling to accommodate increased demand while simultaneously experiencing lower margins. Because consumers are assuming greater financial responsibility for their own healthcare, healthcare delivery networks have to shift from a wholesale to a retail environment where they are interacting directly with patients on issues including pricing, billing, and payment. Unfortunately, hospitals and health networks are experiencing a strong correlation between the use of high deductible plans and the amount of bad debt they are incurring. (Source: HealthCare Finance, 2016)

Concurrently, few healthcare organizations have taken the steps necessary to integrate the many information systems that support revenue cycle management. Systems are incompatible across service lines, locations, and functionality. Different software solutions are frequently employed to support disparate functions such as registration, clinical documentation, and billing.

Even worse, some of these functions may be done manually or are only partially automated, making data analysis incomplete or impossible. As the industry migrates toward value-based care, healthcare organizations are entering new collaborations, taking on risk contracts, exploring alternative sources of revenue, and being pressured to document outcomes.

Patient experience contact centers respond: A leading patient experience contact center offers a patient hotline that strengthens patient trust while managing the organization’s revenue cycle. Contact center agents work with patients to understand their best health plan for them to remain in-network, secure financial clearance, and arrange for a deposit prior to the visit.

This organization celebrates “phone hugs” and is shifting the culture from processing transactions to building relationships with patients through transformative, empathetic conversations.

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The healthcare call center is a vital cog in the strategic success of the health system

By Mark Dwyer

Throughout my thirty years in the healthcare call center industry, I’ve had the pleasure of working with hundreds of quality individuals. Understandably, many have moved on to other roles or retired. Surprisingly though, a good number are still on the job serving as call center managers and call representatives, ten, twenty, and even thirty years later. These dedicated women and men continue to help their local communities connect with necessary healthcare services.

Last month I visited a local call center and ran into a phone representative I had trained on their initial healthcare call center software back in 1993. And she’s not a lone exception. For years, I’ve had the opportunity to watch a number of call centers expand the functions they offer to their communities, while generating additional revenue for their organizations. Today, more than ever, the healthcare call center is not only a nice to have community service but a vital cog in the strategic success of the health system.

My experience last month made me consider how comforting it must be for long-term callers of a local call center to reach out to the same warm, familiar voice with whom they have spoken to for years. And when local patients call the representative, she’s not just another voice on the phone. Instead she’s someone the caller has come to know and trust, someone who is empathetic to her specific needs and engaged in her care.

Over the past three decades, along with personnel changes, health care call centers have undergone many modifications in the communication methodologies used to interact with patients. Now, the once exclusive phone system has been supplemented by emails, text messages, web chats, social media, and more. Interestingly, despite the addition of these new communication methodologies, as recently as five years ago, results continued to show that telephone calls still represented the favored method of interacting with the call center.

Even more interesting, statistics show that speaking over the phone was still the preferred communication tool among adult cell phone owners who use text messaging.

But times are changing. According to a 2014 Workforce Optimization (WFO) market report by DMG Consulting:

The entrance of Millennials into the workforce is driving overdue changes in how people are managed, including innovations in workforce management solutions.

Enterprises are finally starting to build multichannel contact centers that handle calls, emails, and SMS, with use of social media expected to grow over the next three to five years.

Within five to eight years, DMG predicts the number of social media interactions will equal the number of phone calls.

So whether it’s new hardware technologies, product capabilities or communication tools, call centers continue to evolve to remain focused on the importance of enhancing the patient experience. This is more critical now than at any time in our industry’s past. Today, just a few cryptic messages over social media by a disgruntled patient can severely damage the hospital’s or physician’s reputation. Uplifting the patient experience can, and should, be the goal of every call center interaction whether the call is taken by an operator, referral representative, triage nurse, or care coordinator.

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By Katie Owens, MHA, and Richard D. Stier MBA

A large, backlight sign at the entrance to a leading healthcare contact center boldly proclaims: “We own the patient experience.” At another, a team member wears a purple t-shirt that announces in large white letters: “I give phone hugs!”

What’s Going On? Exit the call center. Enter the patient experience (PX) hub. Currently, healthcare has a 29 percent patient experience failure rate, according to research by Hospital Compare. Only 71 percent of inpatient patients receiving care report they received the “best possible care.” In order to positively impact outcomes, it is imperative for healthcare leaders to recognize that an “always” experience begins before a patient receives care and continues after the patient returns home.

Healthcare contact centers are uniquely positioned as the virtual front door for personalized support and referrals before using a clinical service and for individualized follow-up and coaching after discharge. In contrast to legacy call centers that process transactions, today’s patient experience hub is the new nerve center of the organization. It delivers intentionally memorable experiences that mitigate risk, reduce unnecessary readmissions, and solidify loyalty.

With the launch of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) program by CMS in 2006, hospitals have dedicated significant time and resources to improving the results of CAHPS surveys. Increasingly, improving the effectiveness of a health network’s contact center is viewed as an investment to improve the experience of care. This begins at the first touchpoint where someone new to the community calls for a referral to a primary care physician (PCP). It extends to after discharge when a contact center navigator calls to confirm a follow-up visit with that PCP.

This first touchpoint is critical. According to SHSMD (2012), the first three seconds of that initial interaction influences hospital selection and preference.

What Do Patients Want? CAHPS surveys reveal that effective, two-way patient-centered communication is the key differentiator. Here’s the summary.

Patients want to be heard.

Patients want their concerns validated and responded to with respect.

Patients want to be able to trust those who care for their health.

Patients need to understand their treatments and be confident that their care is coordinated.

Patients want to be cared for by engaged employees who make them feel like a top priority. They desire candor and straight talk about what’s going on with them. They want to be assured of responsiveness to ongoing needs.

“Voice of the patient” audio files, recorded with patient permission, provide revealing snapshots of patient perceptions. Here are examples of verbatim patient comments.

Audio transcription #1: “The doctor who did the surgery, his assistant (I guess the nurse), all the nurses that came and worked with me during the night, during my stay, was absolutely fantastic. Each one of them was always smiling and each one of them was always helpful.

“The PT staff that walked with me around the hospital, the staff, the nurse’s staff that I met in the hallway that was always polite and courteous and encouraging. I have never been treated better, and I’ve been in and out of hospitals a lot.

“(This hospital) was absolutely the best place that I have ever received treatment. That’s because of all of the doctors and the nurses and all those that contributed to my care. I just thank you, and God bless you.”

Audio transcription #2: “From beginning to end, it was a totally dissatisfactory performance. They did not register me properly; they did not mail the application information in advance. When I got there, they blamed me that they had mailed it to me. I had to fill out the information while I was there. Even when I gave it to them, the information in the computer was actually information relevant to my father, who had been a patient twenty-six years previously.

“So they had my address listed as his address, which was twenty-six years out of date.

“The actual care that I received was absolutely worthless. The person with whom I spoke had no idea how to respond to any of my questions, and quite frankly, I feel like I know more about sleep apnea than the person to whom I spoke. It was a complete waste of time; I wish I had not gone; and then, finally, I got billed 370 something dollars for the visit. I spoke to somebody for maybe fifteen minutes, and because of insurance, the bill to me ended up being adjusted to $132, which was a total waste of money.”

Delivering What Patients Want: More than eighty-five percent – 85.7 percent of senior healthcare executives surveyed during the first quarter of 2016 – indicate that, “Our organization will be focused on improving patient experience during 2016.” In a separate study, the Deloitte Contact Center Survey found that 62 percent of organizations view customer experience provided through contact centers as a competitive differentiator.

Significant financial consequence secures the priority of improving patient experiences. Based on reports from CMS regarding national healthcare expenditures per capita, the cost of the loss of loyalty – of just one patient deciding not to come back to a specific healthcare organization for the rest of his or her life – could account for $400,000.

By 2020, customer experience will overtake price and product as the key brand differentiator, according to Customer’s 2020 Report. Additional research by The Executive Report on customer experience indicates that 79.7 percent of respondents believe the contact center is involved in defining the customer experience.

Focus Through the Patients’ Eyes: Patient experience (PX) mapping creates a flow chart of every single touchpoint from the patient’s perspective. It identifies all the people, processes, environments, and technologies the patient encounters including call transfers, paperwork, and wait times. PX maps identify how contact centers can strengthen trust and improve handoffs of care.

One leading healthcare contact center conducts their own ongoing patient satisfaction surveys to identify opportunities for improvement before the next CAHPS survey. By the time the CAPHS results are published, they have proactively improved their scores.

Unify Actions With Budgeted Priorities: Contact center PX hubs can choose to support only mission-critical priorities. They can drive physician referrals to the practices of newly employed physicians. They can also serve as a part of the standard of care for reducing preventable readmissions. As reported in the Q2 2016 issue of Provider Advisor, one leading healthcare contact center reduced the organization’s readmission rate by 25 percent, decreased CMS fines by nearly $2 million, and raised the kept appointment rate for post-discharge physician visits to 87 percent.

Energize With Innovation: One organization focused their contact center on physician-to-physician consults for referring physicians to the health system’s specialists and sub-specialists. They received physician-to-physician referrals from dozens of states and several foreign countries. Annual, multi-million dollar results prompted the organization’s president to declare the contact center as her “secret weapon.”

Another organization locates a contact center ambassador in each of their emergency departments to capture patients without a PCP and keep them in network. This initiative that provides a steady stream of newly aligned patients referred to network primary care physicians. Another innovation is the inclusion of patient ratings and comments in online provider directories. The scores and comments about a particular physician from previous patients give prospective patients vital information and increase the likelihood of a good match between patient and provider.

Leverage Technology and Personalize the Experiences: Contact centers can include in the patient record a list of the patient’s health goals for proactive outreach. At discharge they can ask patients for permission to contact a family member or caregiver – and store that information in the patient record – to be accessed when it’s time to make certain they are able to get to their follow-up physician appointment.

One leading healthcare contact center offers a patient hotline that embraces patient trust while managing the organization’s revenue cycle. Contact center agents work with patients to understand their best plan for them to remain in network, secure financial clearance, and arrange for a deposit prior to the visit. That organization celebrates “phone hugs” and is shifting the culture from processing transactions to building trust with patients through transformative, empathetic conversations.

Empower your contact center – your patient experience hub team – to personalize the experiences they provide for callers by thinking carefully through the words they incorporate into their conversations. Ask team members to take the CAHPS survey most closely aligned to the patients they serve. Encourage them to take the survey as a typical patient based on a recent experience they have personally had as a patient. Inquire of each team member:

what they liked about the survey,

what was most challenging about the survey, and

what are three ways the contact center (patient experience hub) can assure the best possible experiences for patients?

Opportunities Await: These examples are a snapshot of the consumer-driven shift that is transforming healthcare contact centers into centralized patient experience hubs. How would your patients benefit from integrating access touchpoints into a patient-centric communications center? How can your organization’s historically generic transactions be replaced with personalized connections that build trust and create loyalty? Perhaps the intersection of contact centers and patient experience is precisely the right destination.

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By Gina Tabone MSN, RNC

In the year 535 BC, Greek philosopher Heraclitus declared, “The only thing that is constant is change.” For many of us working in the healthcare industry, we wholeheartedly agree that these timeless words continue to ring true, year after year. The word change evokes a different response from each of us, but what exactly is change? How is change manifesting itself in today’s healthcare environment, and how can we, as leaders, incorporate the implications of change into our organizational cultures?

Webster’s Merriam Dictionary defines change as: 1. To become different; 2. To make (something or someone) different; 3. To become something else. Change is a modification to the process of doing something. In many cases, the modification is made in hopes of creating a better outcome. Often, the expectation of positive change is put on us without tangible evidence to support a better outcome.

Today’s healthcare leaders rely on innovators and thought leaders who “think outside of the box.” Their role is to introduce variations (that is, changes) to current practices that will ultimately improve patient outcomes, engage their workforce, and contribute to the goals of the organization. Identifying and implementing these variations are vital if we hope to improve outcomes.

For example, without changes within the healthcare industry, there would never have been advancements in immunizations, birth control, and organ transplantation. No change typically means no growth, and no growth is not a sustainable option for any organization.

There are many examples of changes occurring in today’s healthcare environment. The stimuli for most of the modifications are the requisites of the Affordable Healthcare Act. A list must include: healthcare for all, coordination of care, fee for value of care, and accountability for outcomes. Programs such as post-discharge call backs, 24/7 access to clinical care, integrated communication via electronic medical records, and robust patient satisfaction efforts are all outcomes affected by changes that have evolved in an effort to comply with the new regulations. The collateral benefit is quality, efficiency, and exceptional care.

Mention the word change to employees and the reaction is predictable. We have all observed rolling eyes, defensive comments, irritation, anxiety, and resistance. Change represents the unknown, which can be intimidating. Those in charge of healthcare organizations need a long-term change management strategy for their organization and the people affected by it, a strategy that encompasses all aspects of the change, from conception through completion.

A leader who is sincere, humble, and willing to admit to a level of personal angst when going through changes will have more success with overall buy-in efforts from all levels of an organization. Reminders of past organizational achievements often convince employees to give the change a chance. It will hopefully strike a positive chord with front line staff as well, reminding them that they have dealt with change before with positive results. Directly involving those most impacted by the changes is a great way to gain support and alleviate concerns. It is crucial to communicate the fact that the changes occurring are designed to improve patient quality, become more efficient, and enhance both the patient and provider experience.

Change is here to stay; we can count on that. Many of us may not be as open to change, but we can do our best to understand what initiated it and, more importantly, how our role in the process has the potential to influence the accomplishment of organizational goals.

In the famous words of Heraclitus, “The only thing that is constant is change.”

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By Traci Haynes, MSN, RN, BA, CEN

Obesity is one of the greatest public health challenges of this century. It affects more than 600 million people worldwide. The United States leads the world in the number of obese individuals (Khan, 2016). By 2025, a study in the Lancet estimates 43 percent of women and 45 percent of men in the United States will be obese (Lancet, 2016).

There are many tools used to assess for obesity. They include body mass index (BMI) also known as the Quetelet Index, waist circumference, waist-to-hip ratio (WHR), duel-energy x-ray absorptiometry (DEXA), underwater weighing (hydrostatic weighing), isotope dilution, skin calipers, and bioelectric impedance analysis (BIA). The most commonly used tool is BMI, although there is increased use of waist circumference and WHR because of their significance to certain comorbidities.

BMI is weight divided by height in inches squared. There are graphs to calculate BMI or if Internet access is available, then the two measurements can be typed into a BMI calculator. Results less than 18.5 indicate underweight, while 18.5-24.9 is normal, 25-29.9 is overweight, 30-34.9 is obese level I, 35-39.9 is obese level II, and over 40 is extreme, severe, or morbidly obese. For people with severe obesity, life expectancy is reduced by as much as twenty years in men and by about five years in women. The greater reduction in life expectancy for men is consistent with the higher prevalence of android (abdominal) obesity and the higher percent of body fat in women.

BMI is not a perfect measurement, however. Although it typically correlates closely with percent of body fat, some important caveats apply to its interpretation. In mesomorphic or muscular individuals it is not considered accurate as muscle weighs more than fat. It’s important to note that athletes typically skew higher on their BMI index. Also, in some individuals a typically normal BMI may conceal underlying excess adiposity characterized by an increased percent of fat mass and reduced muscle mass.

WHR is calculated as waist measurement divided by hip measurement. The WHO defines obesity in females as being greater than 0.85 and greater than 0.90 in men. Waist circumference should not exceed 35 inches in women and 40 inches in men. Waist circumference and WHR have been used as an indicator or measure of health and the risk of developing serious health conditions. Research shows that people with “apple-shaped” bodies (more weight around the waist), face more health risks than those with “pear-shaped” bodies who carry more weight around the hips. The WHR has been shown to be a better predictor of mortality in older people than waist circumference or BMI. However, other studies have found waist circumference, not WHR, to be a good indicator of cardiovascular risk factors and hypertension in type 2 diabetes.

Obesity carries a negative connotation in numerous societies because of the emphasis that society places on the importance of physical appearance. As a result, individuals with obesity often face prejudice and discrimination (stigmatization) at work, at school, and in the community. Consequently, they may engage in maladaptive eating patterns, binge-eating behaviors, avoidance of physical activity, and increased calorie consumption.

Stigmatization can also occur in the healthcare setting. Physicians, nurses, and other healthcare professionals have self-reported bias and prejudice against overweight and obese patients. Patients who feel stigmatized are more likely to avoid routine preventive care or they may cancel appointments. They may receive compromised care, or there may be a delay in seeking medical attention, which can lead to delayed discovery or treatment of a comorbid condition.

The Rudd Center for Food Policy and Obesity in association with Yale University developed a toolkit for healthcare professionals to help improve clinical practice. Another resource is the Stop Obesity Alliance, which offers “Why Weight? A Guide to Discussing Obesity & Health With Your Patients.” Appreciating the complexity of this disease is an important prerequisite for productive and positive conversation about weight. More and more resources are available for individuals with obesity. One example is the National Obesity Care Week, which is a collaborative effort of the STOP Obesity Alliance, the American Society for Metabolic and Bariatric Surgery (ASMBS), the Obesity Action Coalition (OAC), and the Obesity Society (TOS).

Now, more than ever, healthcare professionals, policymakers, industry, and patient communities must examine their personal perspectives and biases related to obesity and take action to treat obesity as the serious and complex disease it is. The bad news is 80 percent of all diets fail. Of the 20 percent of dieters who do lose weight, approximately 95 percent regain what they lost (or more). Only 5 percent of dieters who lose weight maintain weight-loss. Many diets are not nutritionally balanced, fast food and convenience foods are readily available, and passive entertainment has become the norm (Kline, D., Goedkoop, S., & Bhimji, S., 2014).

The good news is weight loss will bring added energy and better health. A weight loss of 3 percent will reduce blood glucose levels, while a weight loss of 5-10 percent will begin to lower blood pressure, raise HDL, and diminish sleep apnea. A sustained weight loss results in significant health gains. Losing weight and sustaining weight loss is a challenging balance. The average weight loss for most people is 5 to 15 percent and research shows that weight loss takes longer than expected. It sometimes takes a year or more (Kline, D., Goedkoop, S., & Bhimji, S., 2014).

Treatment includes behavior changes especially related to diet and exercise. Unless an individual acquires new eating and physical activity habits, long-term weight reduction is unlikely to succeed. Behavior therapy includes reinforcement that changing eating and physical activity habits will result in a change in body weight. Patterns of eating and physical activity are learned behaviors and can be modified. To alter these patterns over the long term, the environment must be changed.

Learning self-monitoring, stress management, stimulus control, problem solving, contingency management, and cognitive restructuring, especially in setting specific goals, will result in a greater chance of being accomplished. Evidence from the National Weight Control Registry (NWCR), which tracks indices and predictors in individuals who have lost at least thirty pounds and have maintained weight loss for at least one year suggests that patterns associated with successful weight maintenance include self-monitoring of weight, consumption of a low-fat diet, daily physical activity of approximately sixty minutes, minimal sedentary “screen time,” and consumption of most meals at home (NWCR, 2015).

Beyond changing eating habits and increasing physical activity is becoming educated about the body and how to nourish it appropriately, engaging in a support group or extracurricular activity, and setting realistic goals. Individuals who are more actively involved in their healthcare experience have better health outcomes and incur lower costs. This requires educating individuals about their condition and involving them more fully in making decisions about their care, engagement, and activation.

There are numerous diets available. However, it is important to note that many diets don’t provide adequate nutrition. An excellent source for assessing the myriad of diets is available from WebMD. The best way to lose weight and keep it off is a commitment to a lifelong process of proper diet and regular exercise. A diet should include all of the recommended daily allowances (RDAs) for vitamins, minerals, and protein. It should contain plenty of water and fiber and be low in calories. A weight loss program should be directed toward a slow, steady weight loss and include plans for weight maintenance after the weight loss phase is over.

One pound is equal to 3500 calories. Therefore, an individual has to burn 3500 calories more than they consume to lose one pound. Current guidelines recommend lowering energy intake by 500-1000 kcal per day to achieve a weight loss of one to two pounds per week (Goldsmith, C. & Lehrman, S., 2014). Paying attention to the energy value of different foods is essential. Energy dense foods generally have a high caloric value in a small amount of food, while low energy dense foods contain relatively few calories per unit of weight or fewer calories in a large amount of food. Examples of high-energy dense foods include foods that contain animal fats, fried foods, fast foods, sweets, butter, and high-fat salad dressings. Low energy dense food includes vegetables, fruits, lean meat, fish, grains, and beans. It is important to keep in mind portion control and portion distortion and how it has dramatically changed over the years contributing to this disease.

Recommendations for physical activity include at least thirty minutes of moderate-intensity aerobic activity at least five days per week for a total of 150 minutes. Or at least twenty-five minutes of vigorous aerobic activity three days per week for a total of seventy-five minutes. Or a combination of moderate- and vigorous-intensity aerobic activity and moderate- to high-intensity muscle-strengthening activity at least two days per week for additional health benefits.

For lowering blood pressure and cholesterol, an average of forty minutes of moderate- to vigorous-intensity aerobic activity three or four times per week is recommended. Benefits of exercise include improved blood sugar control, increased insulin sensitivity (decreased insulin resistance), reduced triglyceride levels, increased HDL levels, lowered blood pressure, reduction in abdominal fat, reduced risk of heart disease, and release of endorphins (AHA, 2015).

Treatment may involve the addition of medications or ultimately surgery. Medications may amplify adherence to behavior change and may improve physical functioning or make increased physical activity easier in those who cannot exercise initially. However, they are only used in individuals who have health risks related to obesity and only used as an adjunct to dietary modifications and an exercise program.

If an individual’s response to weight loss medications is deemed effective (a weight loss of greater than or equal to 5 percent of body weight at three months) and safe, it is recommended that the medication be continued. If deemed ineffective, or if there are safety or tolerability issues, it is recommended that it is discontinued.

Medicare does not cover medications for obesity, nor do most other insurers. Currently, the three major groups of medications to manage obesity are: 1) centrally acting medications that impair dietary intake; 2) medications that act peripherally to impair dietary absorption; and 3) medications that increase energy expenditure. There are medications that cause weight loss as a side effect and include a diabetic medication an anti-depressive medication and an anti-seizure medication (Endocrinology Advisor, 2015).

Weight loss surgery, known as bariatric surgery, is recommended for people who have clinically severe obesity and have failed to lose weight through diet and exercise. It is recommended for people with a BMI of 40 or greater or BMI over 35 with a serious health problem linked to obesity, men who are one hundred pounds overweight and women who are eighty pounds or more overweight. Weight loss surgery provides clinically significant and relatively sustained weight loss in individuals with severe obesity associated with comorbidities. However, it is expensive, highly procedure, and surgeon specific and not the solution for the growing obesity epidemic.

Emerging research suggests that some complementary and alternative medicine (CAM) therapies may help manage obesity-related conditions. More can be found at The National Center for Complementary and Alternative Medicine’s website, which is part of the National Institutes of Health (NIH).

The disease of obesity is recognized as a growing epidemic, and there is a tremendous amount of research being conducted for the population affected. Building awareness of the disease has also contributed to support groups, coalitions, an increase in educational resources, and health coaching.

Care delivery through an integrated mix of healthcare providers and practitioners, such as physicians, nurses, and dietitians, could play an effective role in combatting obesity and its related chronic diseases. Having a health coach that has knowledge of this disease, its etiology, and contributing factors as well as associated comorbidities, an understanding of stigmatization and bias, past behaviors and those behaviors necessary for change can engage and activate the individuals with obesity and make an enormous impact on helping them to achieve and maintain change for a healthier lifestyle.

A health coach can also provide resources of all types, such as support groups, social services, referrals, and educational documents. A key part of health coaching is utilizing motivational coaching techniques in seeking to understand the person’s frame of reference. The objective is not to solve the individual’s problem but to help them begin to believe change is possible. Techniques are designed to help motivate the individual in a collaborative nature, understand their perspective, and assist them in finding their own solutions, while affirming the freedom to change, thereby allowing them to discover their own motivation.

Having a software solution that provides the framework for coaching interactions and allows the frequency of contact specific to the individual’s needs is one approach in care delivery. It should also include comorbidity coaching, health information, referral capabilities, and a mechanism to set goals and follow-up on these goals, outcome reporting including adherence, and follow-up letters to both the patient and their providers.

The prevalence of obesity continues to grow in the US and worldwide. It affects everyone in some way, but most profoundly affects those with the disease. Interventions are necessary to help control and reverse this epidemic. Health coaching is one way in which to facilitate ongoing interventions with the individuals whom so desperately need clinician oversight.

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Empower Medical Contact Center Agents to Improve Patient Care

By Joshua Feast

Working in a contact center can be difficult under any circumstances. Medical contact centers in particular require a high level of emotional engagement. Patient calls can often be stressful and emotionally trying experiences. An agent’s ability to display empathy, create rapport, and successfully build an emotional connection with a patient is critical in driving resolution and ensuring long-term satisfaction for both agents and patients.

Contact center agents have a tough job. They take medical leave at a rate three times greater than that of employees in other fields (Integrated Benefits Institute). They encounter, on average, ten hostile callers per day (Dr. Guy Winch/Psychology Today). The repetition, stress, and job difficulty takes its toll; the average career span for a contact center worker is just three years.

Agents who successfully develop rapport with patients not only provide better care, they are better able to cope with the emotional labor their job requires, which results in higher job satisfaction. Positive energy is contagious. An agent who develops an emotional connection with a patient on one call feels better about his or her work and carries a sense of optimism into the next call.

Extract Actionable Insights from Subconscious Behavior: Behavioral analytics solutions provide agents with the real-time guidance they need to develop positive emotional connections with patients. These solutions provide insight into agent and patient speaking behavior. They comprehensively measure patient experience and provide deeper awareness into the emotional connection between patient and agent. According to research pioneered by Dr. Alex “Sandy” Pentland at MIT, humans communicate in large part by using “honest signals.” Honest signals are a kind of involuntary language involving vocal expressions, among other gestures, which communicate what’s on our mind more honestly and powerfully than the spoken word can.

Behavioral analytics solutions perform vocal analysis – focusing on pitch, tone, silence, and turn taking – to pick up on these honest signals. They convert speech into signal data, process that data in real time through behavioral models and present guidance to agents as well as a summary of agent performance to contact center managers. For the first time, contact center leaders have the analytics they need to measure and improve emotional connections with patients. Through these novel analytics, medical contact centers can discover whether agents are displaying the conversational skills that ultimately lead to more satisfied patients and more engaged agents.

Behavioral analytics solutions are already affecting healthcare delivery. The US Department of Veterans Affairs, for example, is leveraging behavioral analytics in an attempt to better detect when veterans are at risk for suicide. Mass General Hospital (through MoodNetwork.org) is using this technology to better identify behavioral patterns that can help patients manage depression or bipolar disorder.

Behavioral Analytics Facilitate Continuous Care for Patients: Behavioral analytics solutions empower phone agents to communicate more effectively with patients. This ensures more productive conversations and better call outcomes. The solutions can also be put directly in the hands of patients via a mobile application, making them more aware of their own condition and helping them to seek medical support proactively.

The mobile application can sense patterns in patient behavior to detect potential medical need: Are patients remaining socially connected? Are they active? Are they experiencing large variations in mood? If a patient in need calls in for support, the agent has more context regarding the patient’s medical state and can use that information to take the best actions for the patient’s health.

Behavioral analytics has the potential to help transition care from expensive, episodic, reactive support to continuous proactive care. They provide contextual information for agents and clinicians, ensuring a more comprehensive assessment of health and a better understanding of treatment success.

Emotional Connections Drive Healthy Outcomes: Working in medical contact centers presents a unique challenge. Agents must build rapport with patients who are often making complex inquiries in a fragile emotional state. Behavioral analytics solutions extract insights from voice analysis and digital trace data and convert those insights into real-time, actionable guidance.

Ultimately, behavioral analytics enable agents to build trust with patients, making the experience more positive for both parties. Agents, fueled by successful patient interactions, build confidence, reduce stress, and derive more satisfaction from their jobs. Patients become more engaged in their own care, leading them to live happier, healthier lives. The power of behavioral analytics can transform the medical contact center into an environment rich with empathy, rapport, and positive emotional connections for both agents and patients.

Joshua Feast is CEO and co-founder of Cogito Corp. His focuses are on enabling Cogito’s customers to achieve the next level of enterprise responsiveness and on expanding Cogito’s contribution to the field of human behavior understanding. He has over a decade of delivery to human services, government, and financial services organizations. Joshua holds an MBA from the MIT Sloan School of Management, where he was the Platinum-Triangle Fulbright Scholar in Entrepreneurship, and a Bachelor of Technology from Massey University in New Zealand.

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By Traci Haynes, MSN, RN, BA, CEN

During the last three decades, the prevalence of individuals being overweight or obese has increased significantly in both the United States and globally. In June 2013, the American Medical Association (AMA) officially recognized obesity as a disease. It was reported as a move to both encourage physicians to pay more attention to the condition and spur more insurers to pay for treatments. To date, obesity remains an epidemic in America and internationally as reported by the World Health Organization (WHO). Due to the rapid increase in obesity prevalence and the serious public health consequences, obesity is considered one of the most serious public health issues of the early twenty-first century (WHO, 2012).

The Trust for America’s Health, funded by grants and dedicated to saving lives by making disease prevention a national priority, conducted a study over a decade ago to determine the effectiveness of government action against obesity. The first edition of their report, F as in Fat: How Obesity Policies are Failing in America, was published in 2004. It stated, “Obesity had become an epidemic in America, and is poised to become the nation’s leading health problem and No. 1 killer” (Trust for America’s Health, 2004). It reported that nearly 119 million American adults, 65 percent of the population were overweight or obese, causing 400,000 deaths per year (or 45 per hour) and would soon overtake tobacco use as the leading cause of preventable death. It also reported that the percentage of overweight children had more than doubled and adolescents had tripled since 1980 and that these younger generations may be the first in American history to live sicker and shorter lives than their parents.

There has been an updated report published every year, and in 2007 the Robert Wood Johnson (RWJ) Foundation became involved, investing over $500 million to reverse the childhood obesity epidemic. In 2014 the report was renamed “The State of Obesity.” And in 2015 the numbers are still staggering. However, there is starting to be some improvement especially concerning building awareness, improving nutrition, and increasing activity in schools and in the communities.

The State of Obesity website provides “Fast Facts” on adult obesity and related disorders, obesity in children and teenagers, physical activity, healthy food, and racial and ethnic disparities. These Fast Facts report the ten states with the highest adult obesity rates are in the South and Midwest and most of the states with the lowest obesity rates are in the Northwest or West. The states with the highest adult obesity rates (over 35 percent) are Arkansas, West Virginia, and Mississippi. Colorado has the lowest obesity rate at 21.3 percent and the lowest rate of physical inactivity at 16.4 percent.

There are twenty-two states with an obesity rate above 30 percent, forty-five states are above 25 percent and every state is above 20 percent. Historically, in 1980 no state had an obesity rate above 15 percent; and in 1991, no state had a rate above 20 percent. Now, nationally more than 30 percent of adults, nearly 17 percent of two to nineteen year olds, and more than 8 percent of children ages two to five are obese. Nine of the ten states with the highest rates of type 2 diabetes are in the South and all twelve of the states with the highest rate of hypertension are in the South. For children and teenagers, seven of the ten states with the highest obesity rates for ages ten to seventeen are in the South, while seven of the ten states with the lowest obesity rate for the same age range are in the West. The four states with the highest obesity rate also have the most adults who don’t exercise (State of Obesity, 2015).

Not only is obesity a public health issue in the United States, which has the highest rate of obesity in the world, but it is also a worldwide problem. The WHO reports that worldwide obesity has more than doubled since 1980. In 2014 more than 1.9 billion adults ages 18 or older were overweight with over 600 million being obese. And most of the world’s population live in countries where overweight and obesity kill more people than being underweight.

Obesity was once considered a high-income country problem. However overweight and obesity are now on the rise in low- and middle-income countries, particularly in urban settings. More than 50 percent of the world’s obese population live in ten countries, which includes the US, China, India, Russia, Brazil, Mexico, Egypt, Germany, Pakistan and Indonesia (WHO, 2015).

According to the National League of Cities, the estimated annual cost of obesity in the US is $190.2 billion. Obesity consumes nearly 21 percent of medical spending, and related job absenteeism equals $4.3 billion. Childhood obesity equates to $14 billion in direct medical costs (National League of Cities, 2015).

The Affordable Care Act of 2010 designated two recommended preventive services to be covered at no cost sharing to individuals. The first is dietary counseling for adults at higher risk for chronic disease; and the second is obesity screening and counseling for adults and children ages six and over. In November 2011, Medicare began covering intensive behavioral therapy for individuals with a BMI of 30 or more. Counseling may be covered if it is received in a primary care setting. It covers fifteen minutes of face-to-face individual behavioral therapy sessions or thirty minutes of face-to-group behavioral counseling sessions.

The food industry plays a significant role and could potentially be listed as a contributing factor to the obesity epidemic. Reducing the fat, sugar, and salt content of processed foods would help influence obesity, as would responsible marketing especially that aimed at children and teenagers. Ensuring healthy and nutritious food choices are available and affordable as well as supporting regular physical activity in the school and workplace is essential (WHO, 2015).

Obesity’s etiology is far more complex than simply an imbalance between energy intake and energy output, but this is how it is most commonly explained. In reality it is a complex disease with genetic, biological, economic, environmental, psychosocial, and behavioral determinants. Overeating relates to portion size, eating out, and eating fast food (less expensive), eating all day (a recent study reported many Americans eat fifteen hours per day and most of the calories are consumed after 6 p.m.), eating energy dense, or calorie rich foods, and eating disorders (bingeing, lack of satiety, food-seeking behavior, night-eating syndrome, etc.). Physical inactivity relates to a more sedentary lifestyle. Genetic syndromes such as Prader Willi and others, may affect hormones involved in fat regulation (e.g., a deficiency in leptin and the amount and areas of body fat storage).

Family history most often is attributed to the environment, but heredity can play a part in metabolic rate, spontaneous physical activity and thermic response to food. Age is another factor. As a person ages, there tends to be a loss of muscle mass. Also, physical activity often decreases, and since muscle burns (metabolizes) more calories there is a need for a decreased caloric intake. Foods specific to certain cultures and ethnic populations may be high in salt or fat.

Certain medications can also be a contributing factor, such as some anti-depressants, anticonvulsants, some diabetes medications, certain hormones like birth control pills, some antihypertensives, and most corticosteroids. Emotions influence eating habits, therefore psychological factors can also contribute. Environment plays a role in shaping habits and lifestyle. Driving instead of walking, increased technology for entertainment, and convenience foods have all had an impact on everyday life (Curry, K., Goldsmith, C., & Birn, C., 2015).

The two most commonly reported contributing factors to obesity is overeating and physical inactivity. Portion size today is two to eight times larger than the USDA or FDA standard. In 1955 a fast food restaurant introduced French fries with the original portion weighing 2.4 oz. and having 210 calories. Today, the large size of French fries is 7.1 oz. and has 610 calories. From 1982-2002 the average pizza size grew 70 percent. The average Caesar salad doubled in calories and the average chocolate chip cookie quadrupled in calories. Plate size has grown to hide the larger portions.

The surface area of the average dinner plate has expanded by 36 percent between 1960 and 2007 (Gunders, D., 2012). And the Cornell Food and Brand Lab reported that the serving sizes in the Joy of Cooking cookbook have increased 33.2 percent since 1996. A recipe that used to serve ten, now serves seven, or the ingredient amounts have been adjusted for the greater number of servings. Caloric density and a diet high in simple carbs and fats are also factors (Cornell University Food and Brand Lab, 2015).

Only about one-half of US adults meet the minimum guidelines for aerobic physical activity (150 minutes per week of moderate exercise or 75 minutes per week of vigorous exercise). Youth inactivity numbers are also accelerating, which results in increased health issues and cost. When school systems have to reduce expenses, physical education and sports are often cut back or eliminated. And research has shown inactive children don’t perform as well academically and that an inactive child will more than likely become an inactive adult. Video games and too much TV time is also socializing children to become inactive.

The most common complications and health risks associated with obesity include type 2 diabetes, hypertension, hypercholesterolemia, heart disease, stroke, gallbladder disease, gastroesophageal reflux disease (GERD), osteoarthritis, sleep apnea, and respiratory problems as well as some cancers (colon, endometrial, breast, lung, esophageal, and kidney). There are numerous other complications and comorbidities that would take pages to list, but would help one better understand the enormity of this disease.

The prevalence of obesity continues to grow in our country and worldwide. It affects everyone in some way but most profoundly affects those with the disease. Interventions are necessary to help control and reverse this epidemic. Supportive environments and collaborative efforts focused on reducing obesity and its comorbidities is essential, as is increasing efforts on prevention through massive public education in order to curb the medical and economic burden of this disease.

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A reliable healthcare model for value and outcomes versus volume and revenues

By Mark Dwyer

Imagine the year is 2030. The Cubs have finally won a second World Series. Private companies are shuttling people to the moon. And Garth Brooks has launched yet another comeback tour.

Voice controlled computers, self-driving cars, and nanotechnology are no longer just theory. Finally, technology has done what it promised so many years ago. No more tedious typing and key-boarding classes, paying exorbitant car insurance fees, or washing windows every spring.

Amidst all the change, one thing remains constant – the triage call center. Sure the technology has changed. Newer phones and telephony interfaces exist. Video conferencing and chat windows are now the rage. But despite these changes, the heart and soul of the triage call center remains the same. And it lives within the person of the highly-skilled triage call center nurse.

To the stressed-out mom whose crying newborn cannot be consoled or the scared elderly man alone at home experiencing gut-wrenching abdominal pain, the call center nurse will continue to provide the same heartfelt care she has for the better part of the last forty years. Her calming voice, empathic concern, and level of knowledge will be what the caller really needs. The cold touch of a lifeless computer screen, even if artistically designed, will never replace human interaction.

Technology is critical to our daily lives. Without it, the world as we know it would cease to exist, but too often the warmth and support provided by the triage call center nurse is overlooked by the bean counters who seek discernable ROI. If ever healthcare had a model for value and outcomes versus volume and revenues, the triage call center is it – both now and in the future.